A 'whole new day' in psychiatry

If you can think it, Kilts says, he can image it.

The pleasure Dr. Clint Kilts takes remembering his grandfather is evident. His genial face softens. The corners of his eyes crinkle. "He was a trickster," the neuroscientist chuckles.

Kilts' expression changes in countless subtle ways as he recounts how his grandfather, an oral surgeon, would pick him up on Sunday mornings when he was young, dressed as if for church. Kilts' parents were Catholic, his grandfather was not. Mass was not their destination.

Instead, the pair would head to the racetrack, where grandfather would teach grandson how to handicap horses. When it was about time for Mass to have ended, they would return, stopping by the church on the way so that Clint could run in to pick up the weekly bulletin and go home with no one the wiser.

Or so the boy thought — until the day, years later, when his mother asked him how he enjoyed those trips to the track. "How did you know?" Kilts asked. His delight is obvious as he relates her reply: "Where do you think he took me on Sundays?"

Faces let us glimpse what's going on inside a person. We intuit something about their thoughts and feelings by "reading" infinitesimal changes in their expressions. But Kilts delves deeper. He and his staff at the University of Arkansas for Medical Sciences will be watching changes inside people's brains.

As the founding director of the school's new Brain Imaging Research Center (BIRC), Kilts will command a powerful new, $3 million fMRI (functional magnetic imaging resonance) system. When patients or research subjects enter the fMRI machine, he and his staff, seated at computers in an adjacent room, will be able to watch their brains as they respond to visual or auditory stimuli.

Kilts expects the fMRI to reveal a biological basis for many behaviors that, until now, have been vaguely classified as "mental illnesses." His excitement is evident when he says, "We've never had such a tool before."

"I'm trying to show some of the physicians around here that what we have here is like a cardio stress test that can show heart defects on an electrocardiogram. That came along several years ago, and it's a great tool. Well, now we've reached that point in psychiatry. We have a tool that can see what's happening in the brain. We can actually see the suffering in people."

The fMRI machine is a tube, something like a space capsule. A person lies down in front of it and an operator slides him or her about half-way into it. As the subject lies very still, computers can track activity inside the person's brain with pinpoint accuracy.

"I generally say, if you can think it, we can image it," Kilts says. "That makes illness open to study in a way it never has been before. It's a whole new day in psychiatry."

The BIRC is the newest part of UAMS' Psychiatric Research Institute (PRI) — itself less than two years old and one of just nine facilities in the U.S. devoted to psychiatric research, treatment and teaching. Dr. G. Richard Smith heads both the PRI and the school's Department of Psychiatry. "Most hospitals," he says, "can't afford a facility like this."

Fundamental breakthroughs

But psychiatry — and the need for it — is big at UAMS. With more than 100,000 visits a year, the Department of Psychiatry accounts for one-eighth of the hospital's outpatient visits. Beyond that, many illnesses treated in other departments — such as those related to obesity — are viewed as having a psychiatric component.

Smith wants the PRI not only to excel at treatment, but to understand what goes awry in the organ that controls behavior. As he put it, "I felt that we have got to find out what's going on in the brain." Smith sees the brain, whose activities have remained obscure for so long, as one of medicine's last frontiers.

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